Provider Demographics
NPI:1033573720
Name:THOMAS J. DERBES, M.D., LLC
Entity Type:Organization
Organization Name:THOMAS J. DERBES, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-872-1300
Mailing Address - Street 1:100 DOCTORS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7608
Mailing Address - Country:US
Mailing Address - Phone:850-872-1300
Mailing Address - Fax:850-872-9420
Practice Address - Street 1:100 DOCTORS DR
Practice Address - Street 2:SUITE B
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7608
Practice Address - Country:US
Practice Address - Phone:850-872-1300
Practice Address - Fax:850-872-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME481772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26046OtherBLUE CROSS
FLD53437Medicare UPIN
FL26046BMedicare PIN